Yamamura Kensuke, Yamashita Yo-Ichi, Yamao Takanobu, Kitano Yuki, Arima Kota, Miyata Tatsunori, Higashi Takaaki, Hayashi Hiromitsu, Beppu Toru, Baba Hideo
Department of Gastroenterological Surgery Graduate School of Medical Science Kumamoto University Kumamoto Japan.
Department of Surgery Yamaga City Medical Center Kumamoto Japan.
Ann Gastroenterol Surg. 2022 Feb 12;6(4):555-561. doi: 10.1002/ags3.12554. eCollection 2022 Jul.
The aim of this study was to evaluate risk factors for nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD), with a special focus on remnant pancreatic volume (RPV) as assessed using computed tomography (CT).
From February 2004 to June 2017, 101 patients who underwent PD in our institution were enrolled. We defined a CT attenuation value of less than 40 HU as hepatic steatosis and measured RPV at 7 days, 3 months, and 1 year after PD using the SYNAPSE VINCENT system. The incidence of NAFLD and RPV were compared between the two groups according to reconstruction with pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ).
The incidence of NAFLD at 3 months after PD was 39.6% (40/101). The RPV ratio (RPV at 3 months or 1 year divided by RPV at 7 days after PD) at both 3 months and 1 year was significantly smaller in the PG group than in the PJ group (59% vs 73%, < .001 and 53% vs 67% < .01, respectively). A positive correlation between the RPV ratio and liver CT value at 3 months was found. The multivariate analysis identified three independent risk factors for NAFLD: female sex (odds ratio [OR] 8.16, 95% confidence interval [95% CI] 2.27-35.9, < .001), PG reconstruction (OR 3.87, 95% CI 1.04-15.6, = .04), and RPV ratio ≤60% (OR 3.44, 95% CI 1.06-11.8, = .001).
Atrophic change in the remnant pancreas is significantly associated with the development of NAFLD, and PJ reconstruction may be superior to PG from the viewpoint of NAFLD development.
本研究旨在评估胰十二指肠切除术（PD）后非酒精性脂肪性肝病（NAFLD）的危险因素，特别关注使用计算机断层扫描（CT）评估的残余胰腺体积（RPV）。
2004年2月至2017年6月，纳入在我院接受PD的101例患者。我们将肝脏脂肪变性定义为CT衰减值小于40 HU，并使用SYNAPSE VINCENT系统在PD后7天、3个月和1年测量RPV。根据胰胃吻合术（PG）或胰空肠吻合术（PJ）重建，比较两组NAFLD的发生率和RPV。
PD后3个月NAFLD的发生率为39.6%（40/101）。PG组3个月和1年的RPV比值（PD后3个月或1年的RPV除以PD后7天的RPV）均显著低于PJ组（分别为59%对73%，<0.001；53%对67%，<0.01）。发现3个月时RPV比值与肝脏CT值呈正相关。多因素分析确定了NAFLD的三个独立危险因素：女性（比值比[OR] 8.16，95%置信区间[95%CI] 2.27 - 35.9，<0.001）、PG重建（OR 3.87，95%CI 1.04 - 15.6，=0.04）和RPV比值≤60%（OR 3.44，95%CI 1.06 - 11.8，=0.001）。
残余胰腺萎缩性改变与NAFLD的发生显著相关，从NAFLD发生的角度来看，PJ重建可能优于PG。
